Management of Cardiovascular Metabolic Risks in Obese Children and Adolescents in China: Based on the 2024 Italian Society of Pediatric Endocrinology and Diabetes Position Paper on Cardiometabolic Risk in Children and Adolescents with Obesity

doi:10.12114/j.issn.1007-9572.2025.0118

Chinese General Practice ›› 2026, Vol. 29 ›› Issue (27): 3879-3887.DOI: 10.12114/j.issn.1007-9572.2025.0118

Special Issue: 内分泌代谢性疾病最新文章合辑；儿科最新文章合辑；心血管最新文章合辑

• Guidelines·Consensus·Interpretation • Previous Articles Next Articles

Management of Cardiovascular Metabolic Risks in Obese Children and Adolescents in China: Based on the 2024 Italian Society of Pediatric Endocrinology and Diabetes Position Paper on Cardiometabolic Risk in Children and Adolescents with Obesity

1. General Practice Ward/International Medical Center Ward/Teaching & Research Section/General Practice Research Institute/General Practice Medical Center, West China Hospital of Sichuan University, Chengdu 610041, China
2. Department of General Practice, Guixi Community Health Service Center in Chengdu High Tech Zone, Chengdu 610094, China
3. Day Surgery Center/General Practice Medical Center, West China Hospital of Sichuan University, Chengdu 610041, China

Received:2025-05-14 Revised:2025-08-03 Published:2026-09-20 Online:2026-08-11
Contact: LIU Lidi
About author:
ZHANG Ying and TANG Yijun are co-first authors

中国肥胖儿童青少年心血管代谢风险管理：基于2024年意大利儿科内分泌学和糖尿病学会《肥胖儿童和青少年的心血管代谢风险》立场文件

1．610041　四川省成都市，四川大学华西医院全科医学中心　全科特需病房　全科医学教研室　全科医学研究室
2．610094　四川省成都市，成都高新区桂溪社区卫生服务中心全科医学科
3．610041　四川省成都市，四川大学华西医院全科医学中心　日间手术中心

通讯作者: 刘力滴
作者简介:
张颖与唐以俊为共同第一作者
作者贡献：
张颖、唐以俊负责文章的构思、论文撰写与修订，对文章整体负责；蒋莉华、贾禹、杨荣、杨梓钰、廖晓阳进行论文指导与修订；刘力滴进行文章的可行性分析、参与论文修订、负责监督管理、文章的质量控制及审校。
基金资助:
四川省科技厅项目(2023YFS0027); 四川省卫生健康委科技项目(川干研2023-101)

Abstract

Abstract:

Childhood and adolescents obesity is a critical global public health challenge, posing immediate health risks and increasing the risk of cardiometabolic diseases in adulthood. In 2024, the Italian Society for Pediatric Endocrinology and Diabetology issued a position paper on Cardiometabolic Risk in Children and Adolescents with Obesity, offering significant guidance for the evaluation and management of cardiometabolic risk in obese children and adolescents based on the latest evidence. This article aims to interpret the core content of this document to provide references and recommendations for cardiometabolic risk management of obesity in Chinese children and adolescents.

Key words: Pediatric obesity, Adolescent obesity, Cardiometabolic risk, Comorbidity of obesity, Management

摘要：

儿童青少年肥胖是全球严峻的公共卫生问题，不仅危害当前健康，还增加成年后心血管代谢疾病风险。2024年意大利儿科内分泌学和糖尿病学会发布了《肥胖儿童和青少年的心血管代谢风险》立场文件，基于最新证据为肥胖儿童和青少年的心血管代谢风险评估与管理提供了重要指导。本文旨在解读该文件的核心内容，以期为我国儿童青少年肥胖心血管代谢风险管理提供参考与建议。

关键词: 儿童肥胖, 青少年肥胖, 心血管代谢风险, 肥胖合并症, 管理

CLC Number:

R 589.25

ZHANG Ying,TANG Yijun,LIU Lidi, et al. Management of Cardiovascular Metabolic Risks in Obese Children and Adolescents in China: Based on the 2024 Italian Society of Pediatric Endocrinology and Diabetes Position Paper on Cardiometabolic Risk in Children and Adolescents with Obesity[J]. Chinese General Practice, 2026, 29(27): 3879-3887. DOI: 10.12114/j.issn.1007-9572.2025.0118.
张颖,唐以俊,刘力滴等. 中国肥胖儿童青少年心血管代谢风险管理：基于2024年意大利儿科内分泌学和糖尿病学会《肥胖儿童和青少年的心血管代谢风险》立场文件[J]. 中国全科医学, 2026, 29(27): 3879-3887. DOI: 10.12114/j.issn.1007-9572.2025.0118.

Figures/Tables 2

References 46

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条目	临界值
体质量超标
全身性肥胖^ab
0~<2岁
超重风险	体质量/身长比Z评分>+1且≤+2
超重	体质量/身长比Z评分>+2且≤+3
肥胖	体质量/身长比Z评分>+3
2~<5岁
超重风险	BMI Z评分>+1且≤+2
超重	BMI Z评分>+2且≤+3
肥胖	BMI Z评分>+3
5~8岁
超重	BMI Z评分>+1且≤+2
肥胖	BMI Z评分>+2且≤+3
严重肥胖	BMI Z评分>+3
腹型肥胖
腰围身高比	≥0.60
高血压^c
血压升高	收缩压和/或舒张压（同年龄、性别、身高）：90th~<95th
高血压	收缩压和/或舒张压（同年龄、性别、身高）≥95th（16岁以下）^d收缩压和/或舒张压≥135/80 mmHg（16~18岁）
葡萄糖代谢异常
糖尿病前期
空腹血糖受损	空腹血糖：5.6~<7.0 mmol/L
糖化血红蛋白升高	糖化血红蛋白：5.7%~<6.5%
糖耐量受损	口服葡萄糖耐量试验2 h血糖：7.8~<11.1 mmol/L
糖尿病	空腹血糖≥7.0 mmol/L或糖化血红蛋白≥6.5%或餐后2 h血糖≥11.1 mmol/L^e
血脂异常
低密度脂蛋白胆固醇高	低密度脂蛋白胆固醇≥3.4 mmol/L
高胆固醇血症	总胆固醇≥5.2 mmol/L
高甘油三酯血症	甘油三酯≥1.1 mmol/L（<10岁）或≥1.5 mmol/L（≥10岁）
高密度脂蛋白胆固醇低	高密度脂蛋白胆固醇<1.0 mmol/L
缺乏体育活动
体育锻炼	<60 min/d
久坐行为	≥2 h/d

条目	临界值
体质量超标
全身性肥胖^ab
0~<2岁
超重风险	体质量/身长比Z评分>+1且≤+2
超重	体质量/身长比Z评分>+2且≤+3
肥胖	体质量/身长比Z评分>+3
2~<5岁
超重风险	BMI Z评分>+1且≤+2
超重	BMI Z评分>+2且≤+3
肥胖	BMI Z评分>+3
5~8岁
超重	BMI Z评分>+1且≤+2
肥胖	BMI Z评分>+2且≤+3
严重肥胖	BMI Z评分>+3
腹型肥胖
腰围身高比	≥0.60
高血压^c
血压升高	收缩压和/或舒张压（同年龄、性别、身高）：90th~<95th
高血压	收缩压和/或舒张压（同年龄、性别、身高）≥95th（16岁以下）^d收缩压和/或舒张压≥135/80 mmHg（16~18岁）
葡萄糖代谢异常
糖尿病前期
空腹血糖受损	空腹血糖：5.6~<7.0 mmol/L
糖化血红蛋白升高	糖化血红蛋白：5.7%~<6.5%
糖耐量受损	口服葡萄糖耐量试验2 h血糖：7.8~<11.1 mmol/L
糖尿病	空腹血糖≥7.0 mmol/L或糖化血红蛋白≥6.5%或餐后2 h血糖≥11.1 mmol/L^e
血脂异常
低密度脂蛋白胆固醇高	低密度脂蛋白胆固醇≥3.4 mmol/L
高胆固醇血症	总胆固醇≥5.2 mmol/L
高甘油三酯血症	甘油三酯≥1.1 mmol/L（<10岁）或≥1.5 mmol/L（≥10岁）
高密度脂蛋白胆固醇低	高密度脂蛋白胆固醇<1.0 mmol/L
缺乏体育活动
体育锻炼	<60 min/d
久坐行为	≥2 h/d

心血管代谢风险因素	筛查建议			筛查频率	诊断标准/工具	干预措施
心血管代谢风险因素	≤5岁	6~10岁	>10岁	筛查频率	诊断标准/工具	干预措施
高血压	从2岁起每次就诊常规测血压			每次就诊时	按性别、年龄和身高划分的血压百分位界定：血压升高（90th~<95th）、1期高血压（≥95th）和2期高血压（≥95th+12 mmHg），2~3周内复测确认	生活方式干预（低热量低钠、运动）；6个月无效则考虑药物（ACEI/ARB/CCB），非特殊情况不建议使用利尿剂或β受体阻滞剂
血脂异常	若有心血管疾病家族史或高危因素者2岁起开始筛查空腹血脂	6岁起筛查空腹血脂		1.若检测结果阴性：每3年复查1次； 2.若体质量快速增加或出现其他心脏代谢合并症，则需增加监测频率； 3.若异常，每6~12个月1次	参照表1	生活方式干预（低脂、高纤维饮食、运动）；严重者考虑他汀类药物
糖尿病前期/T2DM		1.6岁起筛查空腹血糖和HbA_1c； 2.若青春期开始时伴有其他危险因素者^a：加做OGTT和HbA_1c	10岁起且伴其他危险因素者^a：加做OGTT和HbA_1c	1.若检测结果阴性：每3年复查1次； 2.若体质量快速增加或出现其他心脏代谢合并症，则需增加监测频率； 3.若处于糖尿病前期：每3个月检测1次空腹血糖、HbA_1c； 4.应在确诊时和每年进行视网膜病变和蛋白尿筛查	参照表1	生活方式干预（饮食+运动）；必要时药物治疗（如二甲双胍±胰高血糖素样肽1激动剂/胰岛素）
MASLD		6岁起若ALT升高或合并其他心血管代谢风险因素，需行肝脏超声		1.血清ALT监测：每2年检测1次（若结果正常）； 2.若体质量快速增加或出现其他心脏代谢合并症，则需增加监测频率； 3.异常结果处理：3~6个月内复查以确认结果，并指导后续实验室检查； 4.脂肪肝患者：每12个月进行1次肝脏超声检查，以评估向肝纤维化演变	超声显示肝脂肪变性；ALT升高（男孩>26 U/L，女孩>22 U/L）	生活方式干预为主（改变饮食、避免含糖饮料、每日运动≥60 min；避免久坐）
PCOS			若出现以下情况，需查激素水平^b：持续性月经周期紊乱伴临床和/或生化高雄激素表现	从月经初潮后2年开始，在每次门诊就诊时进行临床筛查	闭经、月经稀发/异常子宫出血；高雄激素血症的临床和/或生化证据	生活方式干预为主；必要时复方口服避孕药调节激素
OSA	有打鼾、睡眠不安、日间嗜睡、头痛、注意力不集中、多动等症状者进行儿科睡眠问卷筛查；通过多导睡眠图确诊			在每次门诊就诊时进行临床筛查	儿科睡眠问卷+多导睡眠图确诊	腺扁桃体切除术；减重、持续气道正压治疗
缺乏体育活动	评估每日体育活动与久坐时间			在每次门诊就诊时	参照表1	渐进式运动计划（有氧+抗阻）；减少屏幕时间
左心室肥厚		6岁起存在以下合并症时应接受超声心动图检查：确诊高血压、血脂异常、T2DM、MASLD和慢性肾功能衰竭		如出现顽固性高血压或靶器官损害时6~12个月复查	左心室质量指数≥年龄性别第95百分位	控制血压、改变生活方式（限盐、有氧运动）
临床前动脉粥样硬化		在临床实践中，不推荐常规对儿童青少年进行颈动脉-桡动脉脉搏波速度、颈动脉内中膜厚度测量		不推荐		减重、生活方式干预（饮食、运动）
肾功能损害		6岁起查微量白蛋白尿和SCr		1.若检测结果阴性：每年复查1次； 2.出现以下任一情况时改为每半年复查：微量白蛋白尿或SCr异常； 3.合并以下并发症时需每3~6个月复查：高血压、糖尿病前期/T2DM、PCOS	白蛋白尿；eGFR降低（参照表3）	减重、限盐、严格控制血压等

心血管代谢风险因素	筛查建议			筛查频率	诊断标准/工具	干预措施
心血管代谢风险因素	≤5岁	6~10岁	>10岁	筛查频率	诊断标准/工具	干预措施
高血压	从2岁起每次就诊常规测血压			每次就诊时	按性别、年龄和身高划分的血压百分位界定：血压升高（90th~<95th）、1期高血压（≥95th）和2期高血压（≥95th+12 mmHg），2~3周内复测确认	生活方式干预（低热量低钠、运动）；6个月无效则考虑药物（ACEI/ARB/CCB），非特殊情况不建议使用利尿剂或β受体阻滞剂
血脂异常	若有心血管疾病家族史或高危因素者2岁起开始筛查空腹血脂	6岁起筛查空腹血脂		1.若检测结果阴性：每3年复查1次； 2.若体质量快速增加或出现其他心脏代谢合并症，则需增加监测频率； 3.若异常，每6~12个月1次	参照表1	生活方式干预（低脂、高纤维饮食、运动）；严重者考虑他汀类药物
糖尿病前期/T2DM		1.6岁起筛查空腹血糖和HbA_1c； 2.若青春期开始时伴有其他危险因素者^a：加做OGTT和HbA_1c	10岁起且伴其他危险因素者^a：加做OGTT和HbA_1c	1.若检测结果阴性：每3年复查1次； 2.若体质量快速增加或出现其他心脏代谢合并症，则需增加监测频率； 3.若处于糖尿病前期：每3个月检测1次空腹血糖、HbA_1c； 4.应在确诊时和每年进行视网膜病变和蛋白尿筛查	参照表1	生活方式干预（饮食+运动）；必要时药物治疗（如二甲双胍±胰高血糖素样肽1激动剂/胰岛素）
MASLD		6岁起若ALT升高或合并其他心血管代谢风险因素，需行肝脏超声		1.血清ALT监测：每2年检测1次（若结果正常）； 2.若体质量快速增加或出现其他心脏代谢合并症，则需增加监测频率； 3.异常结果处理：3~6个月内复查以确认结果，并指导后续实验室检查； 4.脂肪肝患者：每12个月进行1次肝脏超声检查，以评估向肝纤维化演变	超声显示肝脂肪变性；ALT升高（男孩>26 U/L，女孩>22 U/L）	生活方式干预为主（改变饮食、避免含糖饮料、每日运动≥60 min；避免久坐）
PCOS			若出现以下情况，需查激素水平^b：持续性月经周期紊乱伴临床和/或生化高雄激素表现	从月经初潮后2年开始，在每次门诊就诊时进行临床筛查	闭经、月经稀发/异常子宫出血；高雄激素血症的临床和/或生化证据	生活方式干预为主；必要时复方口服避孕药调节激素
OSA	有打鼾、睡眠不安、日间嗜睡、头痛、注意力不集中、多动等症状者进行儿科睡眠问卷筛查；通过多导睡眠图确诊			在每次门诊就诊时进行临床筛查	儿科睡眠问卷+多导睡眠图确诊	腺扁桃体切除术；减重、持续气道正压治疗
缺乏体育活动	评估每日体育活动与久坐时间			在每次门诊就诊时	参照表1	渐进式运动计划（有氧+抗阻）；减少屏幕时间
左心室肥厚		6岁起存在以下合并症时应接受超声心动图检查：确诊高血压、血脂异常、T2DM、MASLD和慢性肾功能衰竭		如出现顽固性高血压或靶器官损害时6~12个月复查	左心室质量指数≥年龄性别第95百分位	控制血压、改变生活方式（限盐、有氧运动）
临床前动脉粥样硬化		在临床实践中，不推荐常规对儿童青少年进行颈动脉-桡动脉脉搏波速度、颈动脉内中膜厚度测量		不推荐		减重、生活方式干预（饮食、运动）
肾功能损害		6岁起查微量白蛋白尿和SCr		1.若检测结果阴性：每年复查1次； 2.出现以下任一情况时改为每半年复查：微量白蛋白尿或SCr异常； 3.合并以下并发症时需每3~6个月复查：高血压、糖尿病前期/T2DM、PCOS	白蛋白尿；eGFR降低（参照表3）	减重、限盐、严格控制血压等

Management of Cardiovascular Metabolic Risks in Obese Children and Adolescents in China: Based on the 2024 Italian Society of Pediatric Endocrinology and Diabetes Position Paper on Cardiometabolic Risk in Children and Adolescents with Obesity

中国肥胖儿童青少年心血管代谢风险管理：基于2024年意大利儿科内分泌学和糖尿病学会《肥胖儿童和青少年的心血管代谢风险》立场文件

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